Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 38-50: Pesticides: Cholinesterase Inhibitors Poisoning + Key Features Download Section PDF Listen +++ ++ Includes organophosphates and carbamates Inhibit the enzyme acetylcholinesterase and increase acetylcholine activity at nicotinic and muscarinic receptors and in the peripheral and central nervous systems Most are absorbed through intact skin Most chemical warfare "nerve agents" (such as GA [tabun], GB [sarin], GD [soman] and VX) are organophosphates + Clinical Findings Download Section PDF Listen +++ ++ Abdominal cramps Diarrhea Vomiting Excessive salivation Sweating Seizures Lacrimation Constricted pupils Wheezing Bronchorrhea Skeletal muscle fasciculations Weakness Respiratory arrest Initial tachycardia may be followed by bradycardia Symptoms may persist or recur for days, especially with highly lipid-soluble agents such as fenthion or dimethoate + Diagnosis Download Section PDF Listen +++ ++ Serum and red blood cell cholinesterase activity is usually at least 50% below baseline with severe intoxication Serum or urine levels of specific pesticides rarely available nor helpful + Treatment Download Section PDF Listen +++ ++ For recent ingestions, consider gut decontamination by aspiration of the liquid using a nasogastric tube followed by administration of activated charcoal If the agent is on the victim's skin or hair, wash with soap or shampoo and water Care providers should avoid skin exposure by wearing gloves and waterproof aprons Dilute hypochlorite solution (eg, household bleach diluted 1:10) is reported to help break down organophosphate pesticides and nerve agents on equipment or clothing Administer atropine, 2 mg intravenously, and give repeated doses as needed (may need several hundred milligrams) to dry bronchial secretions and decrease wheezing Administer pralidoxime, 1–2 g intravenously, as soon as possible, and give a continuous infusion (200–500 mg/h) as long as there is any evidence of acetylcholine excess Pralidoxime is of questionable benefit for carbamate poisoning